Damn it Jim, Im an EMT not a Doctor EMS Drug-Drug interactions and - PowerPoint PPT Presentation

“Damn it Jim, I’m an EMT not a Doctor” EMS Drug-Drug interactions and how not to be the grim reaper

OBJECTIVES • Examine EMS drugs and the interactions they have with other medications. • Describe potential negative outcomes of drug-drug interactions. • Identify clues from a patient's past medical history that can raise your suspicions of possible drug-drug interactions. • Identify unusual antidotes for overdoses and poisons or atypical uses for certain EMS drugs.

There is a lot of information out there • First off, concerning pregnancy category: – Category A – Safe for pregnant women – Category B – Safe in animal trials, no human trials – Category C – Unsafe in animals, no human trials – Category D – Unsafe in humans, but benefits might outweigh risks – Category X – Unsafe in humans and risks outweigh benefits – Category N – Not rated

EMT 1 Drugs

OXYGEN • Pregnancy Category – N • Bleomycin or Blenoxane – MAJOR interaction • This interaction increases the toxicity of bleomycin and can cause fatal ARDS, pneumonitis and pulmonary fibrosis • <30% O 2 concentration

OXYGEN • AMIODARONE - MAJOR interaction • This interaction between high dose O 2 and amiodarone can cause ARDS • Use lowest amount of oxygen needed to maintain oxygenation

OXYGEN • Fun Facts – Oxygen in high concentrations can cause blindness in newborns.

ASPIRIN (ASA, Acetylsalicylic Acid) • Pregnancy Category – N • 81 Major interactions • IBUPROFEN – MAJOR interaction • Ibuprofen competes with Aspirin and decreases the anti-platelet action • One study showed that heart patients who were on ASA but took ibuprofen were more than twice as likely to die • Generally avoid mixing these two drugs

ASPIRIN • ALL OTHER NSAIDS – MAJOR interaction • Combining aspirin with other NSAIDS increases the risks of GI Bleeding and renal failure

ASPIRIN • ALL OTHER BLOOD THINNERS – MAJOR interaction • Aspirin plus blood thinners increases the risk of… BLEEDING • Generally avoid combining – however, weigh the risk of ASA in the setting of AMI

ASPIRIN • FUN FACTS – Aspirin can cause Reye’s syndrome, avoid its use in kids with fever • 10% of asthmatics are NSAID trigger. You can trigger an asthma attack with aspirin or other NSAIDs • Aspirin OD can cause a bezoar and is on of the drugs for which Activated Charcoal is still used

ACTIVATED CHARCOAL • Pregnancy Category – N • 0 major interactions • Hooray! You can give Charcoal without fear!

EXCEPT

Oral Glucose • Pregnancy Category – N • 0 Major interactions • Again you are “safe” to give oral glucose

EMT 2 Drugs

Narcan • Pregnancy Class – C • 119 Major Interactions • All of the interactions have to do with reversal of opiates, withdrawal risks etc… • There is also a risk of pulmonary edema with both opiates and narcan

EMT 3 Drugs

Epinephrine • Pregnancy Class – C • 37 Major interactions • All TCAs – MAJOR interaction • TCAs markedly increase the pressor effects of norepinephrine and epinephrine • Can cause hypertensive urgency, stroke, etc…

Epinephrine • All non cardioselective beta blocker – MAJOR interaction – Propanolol, nadolol, carvedilol, labetalol, sotalol, etc… • Causes unopposed alpha stimulation and can lead to hypertensive emergency, stroke • Use caution but balance risk vs. need

Epinephrine • Halogenated Anesthetics – MAJOR interaction • Makes the heart very irritable and susceptible to arrhythmia and cardiac death • Not that you will see this in the field but hey, good to know.

Lidocaine • Pregnancy Category – B • 20 Major interactions • Sodium Nitrite – MAJOR interaction • Can cause methemoglobinemia • Avoid the interaction of these two drugs

Lidocaine • Buproprion (Wellbutrin) – MAJOR interaction • Any medication that reduces seizure threshold • Combining these medications can cause seizures • Carefully weight the risks of concomitant administration • By the way, what is the treatment for Lidocaine OD? • Benzodiazepenes

Lidocaine • AIDS medications – MAJOR interaction • Increased serum lidocaine • Increased chance of seizures • Risk vs. Benefits

Atropine • Pregnancy Category – C • 20 MAJOR interactions • All preparations of potassium – MAJOR interaction GI Bleeds/bezoar • Why? • Absolute contraindication

Atropine • Topamax and Zonegran – MAJOR interaction • Causes markedly increased temperature, inhibited sweating and dangerous hyperthermia • Use caution when administering atropine to patients with a seizure history

Morphine • Pregnancy Category – C • 29 MAJOR interactions • Most of these interactions are related to respiratory depression. • However…

Morphine • Droperidol – MAJOR interaction • Prolonged QT syndrome , morphine leads to increased prolongation • Weigh the risks vs benefits

Morphine • Buproprion (Wellbutrin) – this drug by itself increases the risk of seizure • Morphine increases this risk pretty significantly

Morphine • FUN FACTS – Morphine plus gallstones can cause biliary spasms. • Morphine can be given in a neb for terminal COPD or supranuclear palsay

NON SCOPE OF PRACTICE DRUGS THAT ARE COMMON EXPANDED SCOPE

ALBUTEROL • Pregnancy Category – C • 20 MAJOR interactions • Albuterol – Beta Blockers: the effects of both drugs are reduced, use caution • Albuterol – Fingolimod: prolonged QT syndrome

ALBUTEROL • Fun facts: Albuterol is used to treat what serious electrolyte imbalance? – Hyperkalemia

GLUCAGON • Pregnancy Category - B • 0 MAJOR interactions • Glucagon – Indomethicin: decreased effects of glucagon

LASIX • Pregnancy Category – C • 26 MAJOR drug interactions • Lasix – aminoglycoside antibiotics: can cause hearing loss • Lasix – Amiodarone: dysrhythmia and death (all K+ wasting diuretics) • Lasix – Lithium: increased lithium levels and lithium toxicity

• Zofran – Dextromethorphan: Serotonin Syndrome • Adenosine – Tegretol: prolonged effects, up to 40 sec • Amiodarone – 339 other drugs: QT prolongation Preg D • Diphenhydramine – Potassium: just like atropine • Diphenhydramine – sodium oxybate: seizure, coma, death

Antidotes and Unusual treatments • Does anyone know what the treatment/cure for Antifreeze poisoning is? – ETOH • There is a treatment for acetaminophen OD – Mucomyst (Acetylcystine) • Adenosine is counteracted by what common EMS drug of abuse? – Caffeine! • Adenosine is also used in a diagnostic medical procedure… – Chemical stress test

More antidotes and unusual treatments • Glucagon can be used to treat hypoglycemia and… – Esophageal obstruction • What two EMS drugs can be used to treat hyperkalemia – Albuterol and Glucose (with Insulin) • More for your info… Thorazine is a hardcore anti- psychotic med also used to treat… – Hiccups • There is a reversal agent for benzodiazepine, just like narcan for opiates… – Romazicon

• Drugs.com – authoritative source REFERENCES

Thank you very much